Beyond Firefighting: Rethinking Mental Health Strategies in Malaysia

By Dr. Yogarabindranath Swarna Nantha, August 17th, 2025

"Let everything happen to you, beauty and terror. No feeling is final." - Rainer Maria Rilke

As Malaysia’s National Strategic Plan for Mental Health (2020–2025) draws to a close, it is timely to reflect on its outcomes after five years of implementation. Launched in response to a three-fold rise in the prevalence of mental health disorders within just a decade (NHMS, 2019), the plan has not curbed the growing burden. Over the past half-decade, rates of mental illness have continued to climb (Raj et al., 2021).

The situation is particularly alarming among adolescents, where depression, suicidal ideation, and loneliness have all increased between 2017 and 2022 (NHMS, 2022; Ova Galen Centre, 2024). Mental health cases among students more than doubled, rising from 7.9% in 2019 to 16.5% in 2023 (The Sun Daily, 2023). Suicide cases, too, escalated from 981 in 2022 to 1,087 in 2023—a 10% increase (Ova Galen Centre, 2024).

These trends affirm that mental disorders remain among the leading causes of disability and health loss in Malaysia, accounting for 8.6% of total DALYs (Chua, 2020). The economic toll is equally sobering: mental health conditions cost an estimated RM14.46 billion in 2018. If projected forward, this figure could consume up to half of the proposed health budget under RMK-13 (Chua, 2020; CodeBlue, 2025).

Singapore’s recent experience offers a parallel. The National Mental Health and Wellbeing Strategy, launched in 2023, sought to expand community access and raise professional standards of care (Ministry of Health Singapore, 2023). Yet its impact has so far been modest. One in three youths still report severe or extremely severe symptoms of depression, anxiety, or stress (Ministry of Health Singapore, 2024). The economic burden is also mounting—rising from an estimated S$1.7 billion annually in 2016 to a projected S$16 billion per year today, or 2.9% of GDP (Abdil et al., 2021; DUKE-NUS, 2023).

Although some of these trends reflect post-pandemic effects, it is evident that many of the strategies resemble “old wine in a new bottle.” This recycling of familiar approaches helps explain the persistent challenges that continue to plague healthcare systems. What is urgently needed is greater investment in prevention, early intervention, and systematic outcomes tracking.

Both Malaysia and Singapore have placed their emphasis largely on service expansion rather than on structural prevention of mental health conditions. From a population-health perspective, these strategies remain illness-oriented rather than health-oriented, devoting little attention to the unmet needs of society. Addressing such needs is essential for lowering the baseline prevalence of psychological strain and reshaping environments that perpetuate chronic stress. Without this shift, the system risks devolving into perpetual firefighting—catching people mid-fall, while rarely reducing the number who fall in the first place.

With the expiry of the National Mental Health Strategy 2025, Malaysia now stands at a crossroads. The recent Health Reform and White Paper offers a chance to prioritize health promotion and prevention. Yet without leveraging research data to craft targeted, evidence-based policies, there is a real danger that this will become another recycled plan with little transformative impact.

Ultimately, mental health outcomes are inseparable from broader health inequalities, deeply rooted in the social determinants of health. Unless policymakers recognize and address these structural realities, we risk repeating the same mistakes. Societal movements that “operationalize” a social vaccine—through strategies such as social prescribing—offer one way forward. What is needed is a shift beyond reductionist approaches, towards a carefully designed social vaccine: grounded in evidence, informed by contemporary social realities, and aimed at creating environments where mental health can truly flourish.